0109-023 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date J Signature of Contractor + ��
OWNER -BUILDER DECLARATION �-
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct, the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will, maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(, ) I have and will maintain workers' compensation insurance, as required by
Secion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No. 1503906-00
STATE PUND
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is ;ssued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 4' 4 a; Applicant— .9 �'• /ri !
Waming:_Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person:at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Ouinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) %� i`. --- Date
BUILDING PERMIT PERMIT#
DATE`� / VALUATION LOT 010"23 TRACT
&243A"20 68 2985IR-1
JOB SITE APN
ADDRESS
u10-415 VIA P M TA. DEL N01. 7724W -W?
OWNER CONTRACTOR/DESIGNER/ENGINEER
WT HOIAMLIX R)T INV M�v%r'MIJ, ATG,
PO DOX 810 1425 R UN..M.R E Y DRIW
I.A.QAW VA CA 9225: PHE.RLIIX AZ 85034,
(602)257-1616 C.910 4990
USE OF PERMIT
SI1,3'dal,.` 37,3' uMX T3NVRL' XRG
SWO - LOT 68 PI:AI.+Y SPIAC1. PERMIT 1;;OES NOT INCL -13 E 1iE.(XK
WALIA 1100LIAP.A Oil MVEWAY APPROAC H
TRACT CONSTRUCTItDN 4,02too Sr
'PORCHiPA'PraCM
i103.A0 S?
GARAGUCARPORT
or
3161 1Vitay' D cow ov, d:,'1)ns.I."autKTiton
2 ,*1W. 0
MR -Ma "M sumbURY
M°O?313'M Ur° 1"7l`)N Ply
101-000-410-000
$1,1 4134
E3'E.,AW CHWIC PER
$973.0,
WiCHAMML FT�R
101-000-421-000
$1r),Q0
Xi.E0t`id3C.ALFr1t
101-000- 20-1hW
$231-92
P1.UMV010 FN
101.000.419.000
1249.25
STROXCI hif=N FEE - 2 11`)
101-000-24.1 -000
$24.35
ORADINO FEE
101-000-423-000
$20.00
I:i91n''ll i3OVER,1MFgAC.T ME
;$I,w7.00
T IN PUBLIC: P1LAM,-Wait 270 -WO -44.5-000
$108.61
WS•TOT.A.L C 1 0WAIR3 PLA).4 CYIFX,.K $4,801.12
A 0 IMS PR14-I1.A1:1:+ ISRS $0,00
SEP 0 6 2001
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT DATE N,, ,+, f BY DATE FINALED JINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ _
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— Q (
Exhaust Fans
0. K. to Wrap
7 - - cJ
F.A.U.
Framing
Z2 — Z
Compressor
Insulation
�_ �'L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
— p
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
`5-�2
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) G _
COMMENTS:
t
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
CEILINGS:
TYPE: BATTS
WALLS:
TYPE : BATTS
GEN
50-415 VIA PUESTA DEL SOL, LOT 68,LA QUINTA, CALIFORNIA
MANUFACTURER:CERTAINTEED
MANUFACTURER:CERTAINTEED
THICKNESS: R-38
THICKNESS: R-21
RJT HO LICENSE #b9b6
,,gi�pp i
TITLE:�LiPiS!l�rID 7
SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
Yar-'T'ITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003
07/12/2002 10:44 7605646505 RJT HOMES PAGE 01
CITY OF LA QUINTA PAO V1
m a BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner RJT HOMES LLC
Contractor
Permit Number 0109-023
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-415 VIA PUESTA DEL SOL
SFD - LOT 68, PLAN SFIACI. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH, REPLACEMENT JOB
CNIffipf INSPECTION DATE INSP.
FOUNDATION & SETBACK i
FOOTING STEEL a
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB o ._
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
Dv NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING.._ I I %/
HEATING & VENT --VC
FIREPLACE
ROOF
BOND BEAM
O.K. TO wnAp
GROUT O 4' . CO S'
FRAMING
INSULATION
PRE -ROOF
-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR f EXTERIOR LATH
LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SIC' "tK
PLUMBING '
FINAL GAS TEST
TING . FVC
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVEAPPROVALS DO NOT INCLUDE RIGHTTO
TURN ON UTILITIES OR OCCUPY BUILDING